WO1999000062A1 - Delivery system and method for surgical laser - Google Patents
Delivery system and method for surgical laser Download PDFInfo
- Publication number
- WO1999000062A1 WO1999000062A1 PCT/US1998/012652 US9812652W WO9900062A1 WO 1999000062 A1 WO1999000062 A1 WO 1999000062A1 US 9812652 W US9812652 W US 9812652W WO 9900062 A1 WO9900062 A1 WO 9900062A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- laser
- tip
- diamond tip
- delivery system
- surgical
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/201—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser with beam delivery through a hollow tube, e.g. forming an articulated arm ; Hand-pieces therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F11/00—Methods or devices for treatment of the ears or hearing sense; Non-electric hearing aids; Methods or devices for enabling ear patients to achieve auditory perception through physiological senses other than hearing sense; Protective devices for the ears, carried on the body or in the hand
- A61F11/20—Ear surgery
- A61F11/202—Surgical middle-ear ventilation or drainage, e.g. permanent; Implants therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
- A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00787—Surgery of the ear
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00392—Transmyocardial revascularisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B2018/2205—Characteristics of fibres
- A61B2018/2222—Fibre material or composition
- A61B2018/2227—Hollow fibres
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
Definitions
- the present invention relates to an instrument for transmitting laser radiation for application to biological tissue for removal, penetration or treatment of the tissue and more particularly to an instrument for efficiently and accurately delivering laser radiation to a predetermined location on the biological tissue.
- the types of lasers may be grouped into ultraviolet ( 1 93-351 nm), visible wavelength (400-700 nm), and infrared (700-100,000 nm).
- the visible light lasers such as argon (488- 51 4 nm), flashlamp-pumped dye (510 nm), copper vapor (578 nm) and ruby (694 nm), are commonly used for selective photothermalysis, e.g., photocoagulation of vascular and pigmented lesions.
- Laser light within the visible range can be delivered using a number of conventional optical techniques including refractive lenses and quartz fiber optics.
- UV lasers or excimer lasers, which include argon-fluoride ( 1 93 nm) and krypton-fluoride (248 nm), have been used predominantly in photorefractive keratectomy to ablate corneal tissue.
- Excimer lasers have also been reported for ablation of skin. (See, e.g., R.J. Lane, et al. , "Ultraviolet-Laser Ablation of Skin", Arch. Dermato/.- 1 21 : 609-61 7 (May 1 985).)
- U.S. Patent No. 4, 1 26, 1 36 of Auth, et al. describes a transparent scalpel blade connected to a fiber optic waveguide which transports laser radiation to the blade.
- the blade which is preferably synthetic sapphire (Al 2 0 3 ), emits laser radiation through the tapered cutting edge to photocoaguiate the blood.
- U.S. Patent No. 4,627,435 of Hoskin discloses a surgical knife formed from a diamond blade optically coupled to a Nd:YAG laser by a fiber optic bundle. The diamond blade is heated by the laser radiation to provide a cauterizing action while making the incision.
- the diamond blade may also be coupled to a visible laser to provide illumination for enhanced visibility of the incision site.
- U.S. Patent No. 4,693,244 of Daikuzono describes an artificial sapphire tip coupled to a quartz optical fiber to transmit radiation from a Nd:YAG laser. The sapphire tip is heated by the radiation to coagulate the blood at an incision made with a separate surgical blade.
- U.S. Patent 5,320,620 of Long, et. al. describes a laser surgical device with a blunt light emitting element for coagulation.
- the tip which may be sapphire, silica or YAG, is coupled to an optical fiber for receiving laser energy.
- the tip may be coated with a high melting point material to absorb the radiation and heat the tip.
- U.S. Patent No. 5, 1 94,71 2 of Jones describes a single crystal diamond cutting tool with an anti-reflection coating bonded to the entry and exit faces of the cutting tool to provide efficient transfer of laser light, or to concentrate laser light at the desired incision.
- the C0 2 laser is most widely used for surgical applications of ablation and cutting of tissue. It is also more readily available and more economical, costing much less than other types of surgical lasers. While Ho:YAG and Nd:YAG lasers still emit light at a short enough wavelength that conventional optical delivery techniques can be used, because of its position in the far-infrared region of the electromagnetic spectrum, the C0 2 laser cannot be delivered through quartz fiber optics, or silica or sapphire lenses, since these materials are opaque to the 1 0 micron wavelength and absorb the infrared laser radiation.
- C0 2 laser light is typically directed through a series of mirrors in a complex articulating system through which the light is delivered to a handpiece containing a lens which will allow the beam to be focussed in a non-contact manner onto the target location.
- delivery optics for C0 2 laser radiation are disclosed in U.S. Patents No. 5,497,441 of Croitoru, et al. , "Hollow Waveguide Tips for Controlling Beam divergence and Method of Making Such Tips"; Patent No. 5,005,944 of Laakmann, et al.
- TMR laser transmyocardial revascularization
- the wavelength emitted by the Ho:YAG laser, 2.1 microns, like the Nd:YAG, is sufficiently short to permit use of conventional optical delivery techniques, eliminating the delivery limitations experienced with C0 2 lasers.
- Patent No. 5,607,421 of Jeevanandam, et al. describes a laser TMR system which uses a thulium-holmium-chromium:YAG laser (THC:YAG) laser with conventional optical fiber delivery via a catheter passed through the left atrium.
- Ho:YAG or excimer lasers can create a transmural channel with a single pulse synchronized with the R wave (beginning of contraction) of a beating heart.
- R wave beginning of contraction
- the Ho:YAG and excimer lasers utilize low pulse energy and must fire multiple pulses over multiple cardiac cycles, typically without synchronization, in order to form a single channel.
- C0 2 lasers are relatively, readily available, inexpensive and easily maintained, and many hospitals already possess or have access to such lasers.
- Excimer lasers are large, expensive, and difficult to maintain, requiring frequent service, and use highly toxic gas as the lasing medium.
- Yet another advantage of the present invention is to provide a delivery system for inexpensively retrofitting an existing C0 2 laser system for performing C0 2 laser surgery at low power levels.
- the system and method of delivery of laser radiation comprises a flexible hollow waveguide connectable at a first end to a low power C0 2 laser source, a rigid hollow waveguide having a proximal end and a distal end, a coupler for coupling the second end of the flexible hollow waveguide to the proximal end of the rigid hollow waveguide and a diamond tip partially disposed within and extending from the distal end of the rigid waveguide.
- the diamond tip has an entrance face for receiving laser radiation and at least one exit face for transmitting laser radiation toward a target area of biological tissue.
- Means are provided for controlling the rigid hollow waveguide to direct movement of the diamond tip and the laser light emitted therefrom.
- the rigid hollow waveguide is a stainless steel tube with an inner diameter and a smooth, polished internal surface for reflection of the laser radiation. Other materials which meet the reflective and heat absorptive requirements for transmitting the laser radiation may be substituted for the stainless steel.
- the entrance end of the diamond tip has an outer diameter to closely fit within the inner diameter of the rigid waveguide, where it is brazed, glued or otherwise firmly affixed.
- the exit end of the diamond tip may be flat, parallel to the entrance face, curved, to act as a lens providing a focusing function, or beveled, to create one or more blade edges to limit the point(s) of exit of the laser radiation and to provide a cutting edge which may be used in combination with the radiation to simultaneously create and cauterize an incision.
- the diameter and emission location of the radiation leaving the diamond tip are controlled by polishing only the desired exit area of the exit face, leaving the remainder of the diamond with a roughened or "frosted" surface which will reflect the majority of laser radiation back into the body of the diamond so that it can be re-directed out of the exit face.
- the areas of the diamond tip through which no radiation should escape may be bonded with a metal or ceramic coating which reflects the laser light.
- the combination of the flexible waveguide, coupler, rigid hollow waveguide and diamond tip may be used for formation of channels in a transmyocardial revascularization (TMR) procedure.
- TMR transmyocardial revascularization
- a low power C0 2 laser under 1 000 Watts, preferably less than 1 00 W
- the distal end of the assembly is guided to an area of the heart to be revascularized.
- the diamond tip is preferably configured as a flat window or a slightly curved lens, i.e., a lens having a relatively long focal point which will not significantly modify the beam diameter or power density at close range.
- Placement of the diamond tip at the desired location may be by catheter through one of the patient's major vessels, so that the ablation begins on the interior of the beating heart, or through a small incision in the chest wall, with the laser radiation being introduced outside-in, through the exterior (epicardial) portion.
- the diamond tip is placed in direct contact with the tissue of the beating heart for delivery of ablative laser radiation for formation of a channel.
- the tip is advanced as the ablation proceeds to control the depth of the channel.
- the laser pulses be synchronized to the peak of the R-wave of the patient's ECG.
- Monitoring of the TMR procedure is achieved using a three-dimensional image acquisition endoscope with a head-mounted display.
- a similar delivery system in combination with a low power C0 2 laser may be used for performing left ventricular remodeling, a surgical procedure for severe dilated cardiomyopathy in which a section of the enlarged left ventricle is surgically removed to reduce the size of the heart and to increase pumping function.
- the diamond tip is formed as a blade which is frosted or otherwise treated to minimize escape of laser radiation everywhere except at the cutting edge. The cutting edge in combination with the laser radiation allows the simultaneous cutting of the heart tissue and photocoagulation of blood along the incision.
- Treatment of otitis media by perforation of the eardrum can be achieved by combining the delivery system as described for TMR with an otoscope to permit viewing of the tympanic membrane to properly position the perforation.
- an area of the tissue is denatured.
- a diamond tip shaped as a lance, or a diamond lens for focusing the laser to a small point a small area of the denatured tissue is then punctured to provide a vent for pressure behind the eardrum.
- the puncturing is achieved by ablation, cutting, or a combination of both.
- Figure 1 is a diagrammatic view of the laser delivery system of the present invention
- Figure 2 is a side elevation, partially cut away, showing the rigid waveguide and diamond tip of a first embodiment of the delivery system;
- Figures 3a-3d are diagrammatic views of alternative embodiments of diamond tips for use in the delivery system of the present invention, where
- Figure 3a shows a blade having one beveled edge
- Figures 3b and 3c show alternate configurations of blades having two beveled edges
- Figure 3d shows a blade having four beveled edges
- Figures 4a and 4b are diagrammatic views of an alternative embodiment of the rigid waveguide, with Figure 4a being a side elevational view and Figure 4b being a top view;
- Figure 5 is a diagrammatic view of the system for performing a TMR procedure;
- Figures 6a-6d are diagrammatic views of a human heart, partially cut away at the left ventricle, showing the steps of a TMR procedure, where Figure 6a shows initial placement of the diamond tip, Figure 6b shows a channel partially formed in the myocardium, Figure 6c shows a completed channel and Figure 6d shows a plurality of completed channels and a partially completed channel;
- Figures 7a and 7b are diagrammatic views of a human heart showing the steps of a PLV procedure, where Figure 7a shows formation of the incision around the wedge of tissue to be excised, and Figure 7b shows the heart after completion of the procedure;
- Figures 8a and 8b are diagrammatic views of a tympanic membrane, where Figure 8a shows the first step of denaturing the tissue and Figure 8b shows the second step of perforating the tympanic membrane within the denatured area; and Figure 9 is a diagrammatic view of a partial cross-section of a human ear and an otoscope adapted for performing a myringotomy according to the present invention.
- a surgical laser radiation delivery system for use with a low power laser source 1 02 comprises a flexible hollow waveguide 1 04 connectable at a first end 1 06 to laser source 1 02, a rigid hollow waveguide 1 1 2 having a proximal end 1 1 4 and a distal end 1 1 6, a coupler 1 10 for coupling the second end 108 of flexible hollow waveguide 1 04 to the proximal end 1 14 of rigid hollow waveguide 1 1 2 and a diamond tip 1 20 partially disposed within and extending from distal end 1 1 6 of rigid waveguide 1 1 2.
- diamond tip 1 20 has an entrance face 202 for receiving laser radiation and at least one exit 204 face for transmitting laser radiation toward an area of biological tissue 1 00.
- the rigid hollow waveguide 1 1 2 may include means for gripping in the user's hand to support and direct movement of the diamond tip 1 20 and the laser light emitted therefrom, or may be combined with a steerable endoscope to enable guidance.
- Flexible waveguide 104 is preferably be constructed according to the disclosure of Harrington, et al. in Patent No. 5,567,471 , which is incorporated herein by reference.
- the waveguide of Harrington, et al. comprises a hollow tube of flexible, thin-wall silica-glass tube with a protective sheath on its outer surface.
- the inner surface of the tube is coated with a material that is optically reflective at mid-infrared wavelengths, such as silver, so that the coating is optically smooth.
- a dielectric film, such as silver iodide, is deposited on the reflective layer.
- the rigid hollow waveguide 1 1 2 is a stainless steel tube with an inner diameter. and a smooth, polished internal surface for reflection of the laser radiation.
- the inner diameter of waveguide 1 1 2 is preferably on the order of 1 .0 to 1 .5 mm or less to provide greater control over the spatial profile of the output laser beam.
- the outer diameter is determined primarily by the materials used, to assure that the tube can be formed with a smooth internal surface without irregularities form creases or wrinkles which might disrupt the efficient transfer of laser energy.
- the outer diameter may also depend on any requirements for housing waveguide 1 1 2 within some other structure, such as a catheter.
- Other materials which meet the reflective and heat absorptive requirements for transmitting the laser radiation may be substituted for the stainless steel. Such materials include invar, nickel, platinum, and other high specific heat metals or alloys.
- the entrance face 202 of the diamond tip 1 20 has an outer diameter to closely fit within the inner diameter of the rigid waveguide, i.e., on the order of 1 .0 to 1 .5 mm or less, where it is brazed, glued or otherwise firmly affixed, for example, by crimping the end of waveguide 1 1 2 around the tip 1 20.
- the surface of entrance face 202 is preferably flat, perpendicular to the axis of waveguide 1 1 2, and may be coated or bonded with an anti- reflective coating 21 0 such as silicon nitride or silicon carbide, as disclosed in Patent No. 5, 1 94,71 2 of Jones.
- the exit face 204 of the diamond tip 1 20 may be flat, parallel to entrance face 202, as shown in Figure 2, curved, to act as a lens providing a focusing or beam expanding function, or beveled, as shown in Figures 3a-3d, to create one or more blade edges to limit the point(s) of exit of the laser radiation and to provide a cutting edge which may be used in combination with the radiation to simultaneously optically and mechanically cut and induce photocoagulation as the incision is made.
- the phrase "mechanically cut” means the cutting performed using a sharp blade pressed against the tissue, while “optically cut” means removal or separation of tissue by laser ablation, regardless of whether the laser radiation is applied in a contact or non- contact manner.
- FIG. 3a shows a blade 300 with a single beveled edge 302. In this configuration, laser radiation would be emitted only through beveled edge 302, which is also the only cutting edge.
- Figure 3b illustrates a blade 304 with two beveled edges 306,308 to form a lance or spear. Both edges 306,308 can be used to cut, and apex 31 0 can be used to pierce. Laser radiation will be emitted through both beveled edges 306,308.
- Figure 3c shows an alternate two-edge blade 31 2 with beveled edges 314,31 6.
- Edge 314 is long and may be used for larger-area slicing, with apex 31 8 for piercing.
- Figure 3d illustrates a curved blade 320 with four beveled edges 324,326,328,330 formed at the distal end of the blade.
- the diameter and emission location of the radiation leaving the diamond tip may be further controlled by polishing only the desired area of the exit face, leaving the remainder of the diamond with a roughened or "frosted" surface which will reflect the majority of laser radiation back into the diamond so that it can be re-directed out of the exit face.
- the areas of the diamond tip through which no radiation should escape may be bonded or coated with a metal or ceramic film.
- the sidewalls 206 of diamond tip 1 20 are treated with internally reflective coating 208 to minimize escape of laser radiation.
- all areas but the beveled edges may be treated to enhance internal reflection and guide the laser radiation toward edge.
- the beveled edges are formed in accordance with conventional techniques for forming surgical diamond cutting blades, in which a facet is formed at the cutting edge.
- the dimensions of such surgical blades are generally appropriate for use in combination with the inventive laser system.
- the base end of a commercially-available surgical blade manufactured by the Drukker Group may have a width in the range of 0.7 to 1 .4 mm and a thickness of 0.1 7 mm, such that it would easily fit within the interior of the hollow waveguide 1 1 2.
- the base end of the blade may have an entrance face with a shape and an area the just fits within the cross-sectional shape and area of the hollow waveguide to enhance efficiency in capture of the laser radiation incident upon the entrance face and to minimize diffraction losses where the laser radiation impinges upon a corner or edge of the entrance face.
- the entrance face is preferably rounded. Since it may be easier to form the base of a diamond blade with a rectangular or square cross-section, the hollow waveguide may be crimped or otherwise modified to create a corresponding rectangular or square cross-section at its interior with approximately the same cross-sectional area as the base of the blade.
- FIG. 4a and 4b A modification for accommodating an exemplary commercial diamond blade is illustrated in Figures 4a and 4b, showing a hollow waveguide 400 with a circular cross-section at proximal end 402 and a rectangular cross-section at distal end 404 to match the rectangular shape of the base 406 of diamond blade 408.
- the transition 41 0 from circular to rectangular cross-section is made as gradual as possible to retain the smooth internal surface to minimize scattering loss and mode conversion. With the laser radiation being emitted only from beveled edge(s) 41 2, the edge can simultaneously cut the tissue and coagulate the blood at the incision.
- the diamond tip is preferably formed using a single crystal natural diamond, which, ideally, is a type lla diamond.
- Type Ma diamonds are effectively free from nitrogen impurities and have enhanced optical and thermal properties. Other types of diamonds may be used as long as they possess the thermal and optical characteristics required to efficiently transmit infrared laser radiation while tolerating thermally-induced stresses and strains.
- Type lb diamonds (most synthetics) and polycrystaliine diamond films manufactured by chemical vapor deposition (CVD), e.g., DIAFILMTM available from De Beers Industrial Diamond Division, Berkshire, England, may also be used.
- the delivery system of the present invention be used in a TMR procedure for formation of channels in the myocardium.
- a TMR procedure for formation of channels in the myocardium.
- FIG. 5 The distal end 51 6 of hollow waveguide 51 2 is fitted with diamond tip 520 configured as a flattened or slightly curved lens at exit face 524.
- Hollow waveguide 51 2 is axially slidably retained within channel 502 of an endoscope 500 so that it may be extended from at least partially retracted into the housing 530.
- Housing 530 may also contain means for preforming one or more other functions in addition to retaining the waveguide 51 2 and diamond tip 520.
- At least a portion of flexible waveguide 51 0 is also retained within endoscope 500.
- the proximal end 536 of waveguide 51 0 is attached via connector 538 to laser 526.
- housing 530 also retains within sheath 534 a plurality of axially-running control lines 532 which are attached at the distal end 502 for guiding the endoscope 500, as is known in the art, and a plurality of optical fibers 504, a first portion of which provide a source of visible illumination and a second portion of which provide visual feedback to the surgeon in the form of a three dimensional image.
- the three dimensional image which is computer-enhanced using the images obtained via the optical fibers 504, is viewed using a binocular head mounted display 506 which is worn by the surgeon to provide real-time visual feedback in a minimally invasive surgical procedure.
- a three dimensional endoscope system is disclosed and described in International Patent Application Publication Number WO 94/28783 of American Surgical Technologies Corporation, the disclosure of which is incorporated herein by reference.
- One such commercial three-dimensional viewing system is available as the Vista Series 8000 Visualization and Information System, which incorporates the CardioScopeTM, for image acquisition, and CardioViewTM, for the head- mounted display, manufactured by Vista Medical Technologies, Vista Cardiothoracic Surgery Division, of Westborough, Massachusetts.
- the three-dimensional image is produced by a conventional stereoscopic endoscope 500 which converts optical images of an object, in this case, the patient's heart, to left and right video image signals.
- the lenses 51 8,520 may be liquid crystal displays (LCDs), such as described in U.S. Patent 5,532,852 of Kalmanish, or may be passive displays as described in above-referenced International Publication No. WO 94/28783.
- LCDs liquid crystal displays
- ISA EP Visual monitoring of the procedure may be supplemented using known techniques of ultrasonic imaging by placing a ultrasonic probe within the patients esophogus. (See, e.g. , I. Kupferwasser, et al. , "Quantification of mitral valve stenosis by three-dimensional transesophageal echocardiography", Int'l J. Cardiac Imag. , 1 2:241 -247, 1 996.)
- Synchronization of the laser activation with the R waves of the electrocardiogram (ECG) signal utilizes a conventional ECG device 522 which is connected to a trigger pulse generating device 524.
- the trigger pulse is passed to a laser firing circuit which activates the laser 526 on the R wave of the electrocardiographic cycle, when the ventricle is maximally distended.
- An exemplary synchronization system is disclosed in U.S. Patent 5, 1 25,926 of Rudko, et al.
- the method for performing a TMR procedure comprises making one or more small left anterior incisions (thoracotomies) through the fourth, fifth or sixth intercostal space to provide access to the left ventricle area of the heart 602.
- the distal end 604 of an endoscope 606 retaining flexible waveguide 607, hollow waveguide 608 and diamond tip 610 is inserted through and fed into incision 61 2 (indicated by dashed lines) until the tip 610 comes in contact with the pericardium 614.
- Endoscope 606 is configured such that it also retains the viewing optics, including illumination means, for providing a three-dimensional image for viewing using head-mounted display 61 6, which is described above with regard to Figure 5. It also may include guidance means, such as control lines running axially along the length of the endoscope for manipulating the distal end 609 of the endoscope. Such guidance means are known in the art.
- the viewing optics may be housing within a separate endoscope which is inserted through a separate incision near incision 61 2.
- the patient's ECG is monitored using an ECG device 61 8 which provides a trigger signal for activating C0 2 laser 620 in synchrony with the R wave 61 9, as indicated on ECG output display 621 .
- laser 620 emits a pulse of low power 1 0.6 micron laser light, i.e., less that 1 000 W and preferably having a power within the range of 25-50 W, with a beam diameter of approximately 1 mm.
- the laser should have a power density of greater than 5000 W/cm 2 .
- Figure 6b which illustrates portions of both the heart 602 and overall system components, the distal end 607 of endoscope 606 is indicated by dashed lines to show the relative movement of the diamond tip 61 0 for advancing the tip into the heart tissue. It should be noted that, where the viewing and lasing components are housed in a common endoscope, distal end 607 is positioned to achieve the desired depth of view based upon the viewing optical components, since tip 610 can be advanced as needed relative to the distal end 607.
- the laser light emitted through diamond tip 610 in contact with the pericardium 614 ablates the tissue, providing a point of entry without tearing the pericardial tissue, and allows the tip 61 0 to be advanced into the myocardium 622. Triggered by detection of another R wave, the laser radiation ablates the myocardial tissue with which the tip 61 0 is in contact. As the myocardial channel 624 is formed, the tip 61 0 is advanced until the channel extends through the myocardium 622 and the endocardium 626 and, finally, the tip 61 0 extends into the left ventricle 628, as shown in Figure 6c.
- the length of hollow waveguide 608 should be sufficient to allow tip 610 to pass completely through the myocardium 622 and enter the left ventricle 628.
- the tip 61 0 is then backed out through the channel 624 and another channel is begun at a different point on the outer wall of the left ventricle.
- Figure 6d shows three completed channels 624 with another one in the process of being formed.
- a number of channels are formed, typically on the order of 1 5 to 40 channels, with diameters of about 1 mm, to provide the desired improvement in myocardial perfusion.
- activation of the laser may be triggered by the R wave for every n beats, depending on the patient's heart rate. For example, for a rate of 60 beats/minute, n might be selected to be 5, 1 0, or some other integer value. Consideration may also need to be given to how long the laser requires between pulses, with the triggering rate being set to a value corresponding to a period equaling an integer times the heart rate which is greater than the laser recharge cycle.
- the pericardium 61 4 may provide a relatively high amount of initial resistance due to its density. Therefore, as an alternative to the flat or slightly rounded tip, it may be desirable to utilize a lance or spear-type diamond tip, such as that illustrated in Figure 3b, to facilitate perforation of the pericardial tissue.
- the pericardium 61 4 heals almost immediately, as indicated in Figure 6d, while the channels in the myocardium remain patent. Variations in the TMR procedure with the inventive system can occur based upon the method of obtaining access to the myocardium.
- the heart is accessed through catheters placed in the patient's femoral artery and passed through the aorta 630, which can be seen in Figure 6a, across the aortic valve and into the left ventricle 628.
- perforation of the pericardium 61 4 is not required, and the channels are created in the myocardium 622 to a pre-determined depth.
- access is gained in an open chest procedure via a sternotomy or thoracotomy.
- the diamond tip is initially placed in contact with the pericardium 61 4, and the channels are formed completely through the myocardium 622.
- the optical components of the system can be simplified as compared to conventional CO 2 laser-based TMR systems, which require an additional laser, typically helium-neon (He-Ne), which emits a visible red light (632.8 nm), with corresponding optics, for aiming purposes.
- an additional laser typically helium-neon (He-Ne)
- He-Ne helium-neon
- contact, and thus, aiming is readily monitored using the images generated by the 3-D endoscope 606 and viewer 61 6.
- esophageal ultrasonic imaging may also be used to monitor the positioning of the device and the progress of the procedure.
- An important advantage of the present invention is that, because of its low power requirements, it may be used with virtually any C0 2 laser head, including retrofitting of a CO 2 laser which may already be available within the hospital.
- This provides greater access to TMR capability for hospitals which may not have the budget for purchasing dedicated TMR systems, which systems cost well over $ 1 00,000, and makes it possible to perform the procedures more cost effectively.
- the contact procedure allows the power level to be significantly lower than that required for non-contact CO 2 laser- based systems, which require power levels of 800 W and up in order to supply sufficient energy to create a complete channel in a single pulse.
- a non-contact TMR system must create the channel in a single pulse since exact positioning of a subsequent pulse at the same point may be difficult on the beating heart.
- the contact delivery system of the present invention allows for greater precision and improved safety, while providing a more economical means for performing TMR procedures.
- the laser delivery system of the present invention may be used to perform a partial left ventriculectomy (PLV), also known as the Batista procedure, for treatment of severe dilated cardiomyopathy.
- PLV partial left ventriculectomy
- the same low power C0 2 laser may be used as that used for the TMR procedures.
- Other types of lasers, such as Ho:YAG or Nd:YAG may be used, however, the advantages of cost savings with the low power C0 2 laser may not be available.
- the diamond tip used for the delivery system will have at least one cutting edge, and may be any of the configurations shown in Figures 3a-3d, or variations thereupon.
- the method of performing a PLV using the inventive system comprises providing access to the heart by way of a sternotomy or thoracotomy.
- MIDCABTM minimally invasive surgery
- the patient is placed on a heart-lung bypass machine.
- the heart continues beating in order to permit identification of the area to be removed.
- the diamond tip 702 shown here with two beveled edges 704,706, is retained within hollow waveguide 730 and is used to simultaneously cut and irradiate tissue in the wall of the left ventricle 708 between the papillary muscles (not shown) to remove a wedge of tissue 71 0.
- the laser radiation is emitted through edges 704,706 to facilitate cutting, particularly through the pericardium 71 2, and to induce photocoagulation of the tissue as the incision is made through the myocardium 71 4 and endocardium 71 6 thus reducing bleeding.
- the stippling at the incision through the myocardium 71 4 is provided to indicate photocoagulated tissue.
- the dotted line indicates the intended line of incision 720.
- lasers may be substituted for the low power C0 2 laser in this procedure in order to provide photocoagulation of the tissue as the incision is made mechanically with the diamond blade.
- Alternative lasers include Ho:YAG, Nd:YAG, and solid state, all emitting within the IR range.
- Other lasers are known for their photocoagulation capabilities including argon and excimer.
- the laser delivery system of the present invention provides several advantages over current PLV techniques. These advantages includes reduced tearing of the heart tissue resulting from conventional steel blade knives or surgical scissors, since the diamond blade has a much cleaner, sharper edge, which produces less cell damage, and the laser radiation augments the mechanical cutting with ablation, at least with the C0 2 laser, and induces photocoagulation to reduce bleeding as the cut is made with the C0 2 laser as well as many other types of laser. These advantages, in turn, reduce the time in surgery and the risk of post-operative bleeding, and contribute to faster healing.
- a third embodiment of the inventive laser delivery system may be used for performing a myringotomy for treatment of otitis media.
- two different diamond tips may be used.
- the first diamond tip 802 mounted within hollow waveguide 804, shown in Figure 8a is configured as an expanding lens which slightly enlarges the diameter of beam 81 6 from a low power C0 2 laser 81 4, e.g., 25-50 W, to irradiate an area 806 on the tympanic membrane 808, preferably, but non-necessarily non-contact (for the patient's comfort), resulting in the denaturing of the tissue in the area 806.
- the denaturing is indicated by stippling.
- Second diamond tip 81 0 may be configured as a focusing lens, a flat window, or a lance-type blade as shown. The key to second diamond tip 81 0 is that it generates a narrower, more focused beam than that delivered by first diamond tip 802 so that a smaller area of impact is defined on the tympanic membrane 808 with a higher power density.
- the smaller, diameter, higher power density beam is then used to ablate a small perforation 81 8 generally at the center of the area of the denatured tissue 806 so that a rim 820 of denatured tissue remains around the perforation.
- This latter aspect of the procedure is preferably performed in two steps.
- the first step is that a small "vent" hole is formed to release any pressure that has built up behind the tympanic membrane which could otherwise lead to bursting of the membrane if it were suddenly perforated.
- a larger perforation is formed to provide the desired drainage.
- the small vent hole may be created by gently pushing the tip 822 of the lance blade 810 against the membrane, then backing the blade away from the tissue to allow the pressure release.
- the desired, larger perforation 81 6 can then be created by a combination of mechanical pressure from the blade 81 0 and the laser ablation, or by either alone.
- the rim of denatured tissue 820 retards the healing of the perforation, giving it extended patency. This eliminates the need for placement of a shunt for drainage such as is required in most current myringotomy procedures.
- Illumination source 832 may double as the targeting means, and, in this case, is shown as a He-Ne laser along with the appropriate optics for directing the beam 834 from the He-Ne laser 832 along substantially the same optical path as, or to convergence with, the ablation laser 81 4.
- the myringotomy procedure is not limited to the wavelength emitted by a C0 2 laser, and a wide range of laser wavelengths may be used, including lasers emitting in the near- and mid-IR, including Ho:YAG, and near- UV ranges, such as excimer.
- the only requirement is that the laser radiation must be sufficient for achieve adequate denaturing of the tissue as required for extended patency of the perforation.
- Patent No. 5,280,378 of Lombardo describes a cyclically scanned laser for use in myringotomy procedures.
- the scanned beam forms many tiny holes in the tympanic membrane to outline an area which can then be punched through at the perforations.
- the laser is used only for cutting/piercing, and no intentional denaturing occurs.
- the patency of the perforation is not improved significantly relative to mechanical lancing procedures and a shunt will still be required.
- the laser delivery system of the present invention provides means for precise control of surgical lasers, especially C0 2 lasers, allowing the safe usage of inexpensive conventional lasers for advanced laser surgical techniques.
- the delivery system allows hospitals and physicians to avoid the significant expense involved in purchasing new, dedicated laser surgical systems when they already have access to C0 2 lasers which were part of an older and possibly out-of-date surgical system.
- the combined laser and mechanical surgical techniques which are enabled by the low power levels allow surgeons to exploit the benefits of each technique without compromise, providing significant advantages over prior art laser systems, particularly for transmyocardial revascularization and myringotomy procedures.
- the disclosed invention introduces the use of laser techniques for use in partial left ventriculectomy procedures and similar cardiac surgeries. Other surgical procedures not specifically mentioned will similarly benefit from the improvements disclosed herein relating to laser delivery.
Abstract
Description
Claims
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU79756/98A AU7975698A (en) | 1997-06-30 | 1998-06-17 | Delivery system and method for surgical laser |
JP50559999A JP2002507135A (en) | 1997-06-30 | 1998-06-17 | Transmission system and method for surgical laser |
EP98930346A EP0993279A1 (en) | 1997-06-30 | 1998-06-17 | Delivery system and method for surgical laser |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/885,064 US5951543A (en) | 1997-06-30 | 1997-06-30 | Delivery system and method for surgical laser |
US08/885,064 | 1997-06-30 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1999000062A1 true WO1999000062A1 (en) | 1999-01-07 |
Family
ID=25386048
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1998/012652 WO1999000062A1 (en) | 1997-06-30 | 1998-06-17 | Delivery system and method for surgical laser |
Country Status (6)
Country | Link |
---|---|
US (1) | US5951543A (en) |
EP (1) | EP0993279A1 (en) |
JP (1) | JP2002507135A (en) |
CN (1) | CN1261774A (en) |
AU (1) | AU7975698A (en) |
WO (1) | WO1999000062A1 (en) |
Cited By (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2001000100A1 (en) * | 1999-06-29 | 2001-01-04 | Drukker International Bv | Cutting blade for surgical instrument |
WO2001087176A1 (en) * | 2000-05-15 | 2001-11-22 | Clinicon Corporation | Optical surgical system and method |
EP1211997A2 (en) * | 1999-08-11 | 2002-06-12 | CeramOptec GmbH | Diode laser scalpel |
JP2002281970A (en) * | 2001-01-17 | 2002-10-02 | Univ Osaka | Method for processing cell |
EP1740988A2 (en) * | 2004-04-08 | 2007-01-10 | OmniGuide, Inc. | Photonic crystal fibers and medical systems including photonic crystal |
EP2083904A2 (en) * | 2006-11-03 | 2009-08-05 | Mobius Therapeutics, LLc | Apparatus and method for application of a pharmaceutical to the tympanic membrane for photodynamic laser myringotomy |
WO2012013687A1 (en) * | 2010-07-30 | 2012-02-02 | Element Six N.V. | A diamond window component for a laser tool |
US8486123B2 (en) | 2003-05-28 | 2013-07-16 | Bredent Medical Gmbh & Co., Kg | Micro-organism-reducing device |
RU2533523C2 (en) * | 2009-07-23 | 2014-11-20 | Конинклейке Филипс Электроникс Н.В. | Optic blade and electric hair cutting device |
US9063299B2 (en) | 2009-12-15 | 2015-06-23 | Omni Guide, Inc. | Two-part surgical waveguide |
Families Citing this family (96)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6096041A (en) * | 1998-01-27 | 2000-08-01 | Scimed Life Systems, Inc. | Bone anchors for bone anchor implantation device |
US6468271B1 (en) * | 1999-02-24 | 2002-10-22 | Scimed Life Systems, Inc. | Device and method for percutaneous myocardial revascularization |
WO2001026569A1 (en) * | 1999-10-08 | 2001-04-19 | Advanced Research & Technology Institute | Apparatus and method for non-invasive myocardial revascularization |
WO2001030429A1 (en) * | 1999-10-22 | 2001-05-03 | Scimed Life Systems, Inc. | Guided injection device |
US6974452B1 (en) | 2000-01-12 | 2005-12-13 | Clinicon Corporation | Cutting and cauterizing surgical tools |
US6872226B2 (en) * | 2001-01-29 | 2005-03-29 | 3F Therapeutics, Inc. | Method of cutting material for use in implantable medical device |
US6464693B1 (en) | 2000-03-06 | 2002-10-15 | Plc Medical Systems, Inc. | Myocardial revascularization |
US6673065B1 (en) * | 2000-07-31 | 2004-01-06 | Brookhaven Science Associates | Slender tip laser scalpel |
US6522827B1 (en) * | 2000-10-11 | 2003-02-18 | Trimedyne, Inc. | Laser devices for performing a myringotomy |
US20020107510A1 (en) * | 2001-02-05 | 2002-08-08 | Andrews Robert R. | Laser apparatus useful for myocardial revascularization |
US20030181940A1 (en) * | 2001-02-28 | 2003-09-25 | Gregory Murphy | Ventricular restoration shaping apparatus and method of use |
US6681773B2 (en) * | 2001-02-28 | 2004-01-27 | Chase Medical, Inc. | Kit and method for use during ventricular restoration |
US20020133227A1 (en) * | 2001-02-28 | 2002-09-19 | Gregory Murphy | Ventricular restoration patch apparatus and method of use |
AU2002316040A1 (en) * | 2001-04-19 | 2002-11-05 | Lumenis Inc. | Method of ablating biological material with electromagnetic radiation delivered by an optical fiber |
US20040243170A1 (en) * | 2001-09-05 | 2004-12-02 | Mitta Suresh | Method and device for percutaneous surgical ventricular repair |
US7485088B2 (en) * | 2001-09-05 | 2009-02-03 | Chase Medical L.P. | Method and device for percutaneous surgical ventricular repair |
US8396549B2 (en) * | 2001-11-29 | 2013-03-12 | Medtronic, Inc. | Papillary muscle stimulation |
BR0312430A (en) | 2002-06-19 | 2005-04-26 | Palomar Medical Tech Inc | Method and apparatus for treating skin and subcutaneous conditions |
US7259906B1 (en) * | 2002-09-03 | 2007-08-21 | Cheetah Omni, Llc | System and method for voice control of medical devices |
DE10245140B4 (en) * | 2002-09-27 | 2005-10-20 | Dornier Medtech Laser Gmbh | Intelligent therapy fiber |
DE10300091A1 (en) * | 2003-01-04 | 2004-07-29 | Lubatschowski, Holger, Dr. | microtome |
IL154101A0 (en) * | 2003-01-23 | 2003-07-31 | Univ Ramot | Minimally invasive controlled surgical system with feedback |
IL154120A (en) * | 2003-01-24 | 2008-11-26 | Sialo Lite Ltd | System and method for pulverizing stones and for scar removal in soft tissues |
CN2885311Y (en) | 2006-01-18 | 2007-04-04 | 郑成福 | Via urethra prostate therapeutic equipment using photodynamic therapy |
EP1613202B1 (en) | 2003-03-27 | 2011-02-09 | The General Hospital Corporation | Apparatus for dermatological treatment and fractional skin resurfacing |
US20050015123A1 (en) * | 2003-06-30 | 2005-01-20 | Paithankar Dilip Y. | Endovascular treatment of a blood vessel using a light source |
US7349589B2 (en) * | 2004-04-08 | 2008-03-25 | Omniguide, Inc. | Photonic crystal fibers and medical systems including photonic crystal fibers |
US7331954B2 (en) | 2004-04-08 | 2008-02-19 | Omniguide, Inc. | Photonic crystal fibers and medical systems including photonic crystal fibers |
US7167622B2 (en) * | 2004-04-08 | 2007-01-23 | Omniguide, Inc. | Photonic crystal fibers and medical systems including photonic crystal fibers |
US7413572B2 (en) | 2004-06-14 | 2008-08-19 | Reliant Technologies, Inc. | Adaptive control of optical pulses for laser medicine |
US20070179486A1 (en) * | 2004-06-29 | 2007-08-02 | Jeff Welch | Laser fiber for endovenous therapy having a shielded distal tip |
US20050288655A1 (en) * | 2004-06-29 | 2005-12-29 | Howard Root | Laser fiber for endovenous therapy having a shielded distal tip |
US20060122584A1 (en) * | 2004-10-27 | 2006-06-08 | Bommannan D B | Apparatus and method to treat heart disease using lasers to form microchannels |
US20060111698A1 (en) * | 2004-11-22 | 2006-05-25 | Kihong Kwon | Apparatus and method for performing laser-assisted vascular anastomoses |
CN1291699C (en) * | 2005-03-30 | 2006-12-27 | 朱汉章 | Series closure operation needle knife |
DE102005017798A1 (en) * | 2005-04-18 | 2006-11-09 | Dornier Medtech Laser Gmbh | optical fiber |
US7856985B2 (en) | 2005-04-22 | 2010-12-28 | Cynosure, Inc. | Method of treatment body tissue using a non-uniform laser beam |
US20070047932A1 (en) * | 2005-08-31 | 2007-03-01 | Branson Ultrasonics Corporation | Waveguide for plastics welding using an incoherent infrared light source |
US7519253B2 (en) | 2005-11-18 | 2009-04-14 | Omni Sciences, Inc. | Broadband or mid-infrared fiber light sources |
US20070142885A1 (en) * | 2005-11-29 | 2007-06-21 | Reliant Technologies, Inc. | Method and Apparatus for Micro-Needle Array Electrode Treatment of Tissue |
EP1803454A1 (en) * | 2005-12-30 | 2007-07-04 | Dornier MedTech Laser GmbH | Treatment of cancer by a combination of non-ionizing radiation and androgen deprivation |
US20070244371A1 (en) * | 2006-04-04 | 2007-10-18 | Nguyen Hoa D | Phlebectomy illumination device and methods |
US7583876B2 (en) * | 2006-06-30 | 2009-09-01 | Schott Corporation | Illuminable image-conducting optical assembly including light-conductive optics housing for creating an illuminating halo |
US7586957B2 (en) | 2006-08-02 | 2009-09-08 | Cynosure, Inc | Picosecond laser apparatus and methods for its operation and use |
US20080051770A1 (en) * | 2006-08-22 | 2008-02-28 | Synergetics, Inc. | Multiple Target Laser Probe |
US20080077122A1 (en) * | 2006-09-22 | 2008-03-27 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Sterilizing cutting method |
US20080077145A1 (en) * | 2006-09-22 | 2008-03-27 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Sterilizing cutting system |
EP1914576B1 (en) * | 2006-10-17 | 2019-01-16 | Dornier MedTech Laser GmbH | Laser applicator with an optical lightguide, the optical lightguide comprising a photorefractive section having a volume hologram. |
JP2008136671A (en) * | 2006-12-01 | 2008-06-19 | Pentax Corp | Laser probe for binocular type three-dimensional endoscope |
US9033999B2 (en) | 2006-12-04 | 2015-05-19 | Implicitcare, Llc | Surgical threading device with removable suture |
US20080132931A1 (en) * | 2006-12-04 | 2008-06-05 | Gregory Paul Mueller | Skin puncturing device |
US7740647B2 (en) * | 2006-12-04 | 2010-06-22 | Implicitcare, Llc | Necklift procedure and instruments for performing same |
US8951271B2 (en) | 2006-12-04 | 2015-02-10 | Implicitcare, Llc | Surgical threading device and method for using same |
US7566340B2 (en) * | 2006-12-04 | 2009-07-28 | Implicitcare, Llc | Surgical threading device and method for using same |
US8025671B2 (en) * | 2006-12-04 | 2011-09-27 | Implicitcare, Llc | Surgical threading device and method for using same |
US20080132946A1 (en) * | 2006-12-04 | 2008-06-05 | Gregory Paul Mueller | Skin port |
WO2008153999A1 (en) * | 2007-06-08 | 2008-12-18 | Cynosure, Inc. | Thermal surgery safety apparatus and method |
US8160678B2 (en) * | 2007-06-18 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Methods and devices for repairing damaged or diseased tissue using a scanning beam assembly |
US8105233B2 (en) * | 2007-10-24 | 2012-01-31 | Tarek Ahmed Nabil Abou El Kheir | Endoscopic system and method for therapeutic applications and obtaining 3-dimensional human vision simulated imaging with real dynamic convergence |
ES2710180T3 (en) | 2008-04-25 | 2019-04-23 | Dornier Medtech Laser Gmbh | Light-based device for the endovascular treatment of pathologically altered blood vessels |
US7734133B2 (en) * | 2008-05-15 | 2010-06-08 | Lockheed Martin Corporation | Hollow core waveguide for laser generation of ultrasonic waves |
US20100280328A1 (en) * | 2009-05-01 | 2010-11-04 | Tyco Healthcare Group, Lp | Methods and systems for illumination during phlebectomy procedures |
WO2012114334A1 (en) | 2011-02-24 | 2012-08-30 | Ilan Ben Oren | Hybrid catheter for endoluminal intervention |
DE102012008911A1 (en) * | 2011-05-11 | 2012-11-15 | J. Morita Mfg. Corp. | Outer tube, laser transmission path and laser treatment tool |
US8655431B2 (en) * | 2011-05-31 | 2014-02-18 | Vanderbilt University | Apparatus and method for real-time imaging and monitoring of an electrosurgical procedure |
US9757038B2 (en) | 2011-05-31 | 2017-09-12 | Vanderbilt University | Optical coherence tomography probe |
KR102183581B1 (en) | 2012-04-18 | 2020-11-27 | 싸이노슈어, 엘엘씨 | Picosecond laser apparatus and methods for treating target tissues with same |
CN103654701B (en) * | 2012-09-05 | 2016-08-10 | 青岛奥美克医疗科技有限公司 | A kind of apparatus and method of antifog endoscopic system |
US20140081289A1 (en) | 2012-09-14 | 2014-03-20 | The Spectranetics Corporation | Lead removal sleeve |
US20210390330A1 (en) * | 2012-12-20 | 2021-12-16 | Sarine Technologies Ltd. | System and method for determining the traceability of gemstones based on gemstone modeling |
US10537236B2 (en) | 2013-01-17 | 2020-01-21 | Stryker Corporation | Anti-fogging device for endoscope |
US10582832B2 (en) | 2013-01-17 | 2020-03-10 | Stryker Corporation | System for altering functions of at least one surgical device dependent upon information saved in an endoscope related to the endoscope |
US10835279B2 (en) | 2013-03-14 | 2020-11-17 | Spectranetics Llc | Distal end supported tissue slitting apparatus |
EP2973894A2 (en) | 2013-03-15 | 2016-01-20 | Cynosure, Inc. | Picosecond optical radiation systems and methods of use |
KR101478463B1 (en) * | 2013-10-10 | 2014-12-31 | 가천대학교 산학협력단 | An illumination chopper |
CN106061423B (en) * | 2013-10-24 | 2019-02-15 | 波士顿科学医学有限公司 | The monitoring of surgical laser treatment temperature |
US10213098B2 (en) | 2013-11-08 | 2019-02-26 | Welch Allyn, Inc. | Laser configured otoscope |
US9804084B2 (en) * | 2013-11-11 | 2017-10-31 | Amphenol Thermometrics, Inc. | Optical gas sensor |
WO2016044640A1 (en) * | 2014-09-18 | 2016-03-24 | Omniguide, Inc. | Laparoscopic handpiece for waveguides |
US10052154B2 (en) * | 2014-10-01 | 2018-08-21 | Verily Life Sciences Llc | System and method for fluorescence-based laser ablation |
EP3217907B1 (en) * | 2014-11-14 | 2023-04-12 | Boston Scientific Scimed, Inc. | Surgical laser systems and laser devices |
US20160181470A1 (en) * | 2014-12-18 | 2016-06-23 | Trustees Of Princeton University | High peak power quantum cascade superluminescent emitter |
EP3067005B1 (en) * | 2015-03-13 | 2017-11-08 | Max-Planck-Gesellschaft zur Förderung der Wissenschaften e.V. | Laser surgery apparatus for contact laser surgery |
US20160375264A1 (en) * | 2015-06-24 | 2016-12-29 | Edgar Dan Laperriere | Light wave treatment instrument and methods of use |
CN109073198A (en) * | 2016-03-29 | 2018-12-21 | 皇家飞利浦有限公司 | Cutting element for hair cutting equipment and the method that manufactures it |
US11684420B2 (en) | 2016-05-05 | 2023-06-27 | Eximo Medical Ltd. | Apparatus and methods for resecting and/or ablating an undesired tissue |
US20170325886A1 (en) | 2016-05-16 | 2017-11-16 | Omniguide, Inc. | Multi-function handpieces for energy-based surgery |
DE102016216443A1 (en) * | 2016-08-31 | 2018-03-01 | Schott Ag | Illumination system with heterogeneous fiber arrangement |
JP6803797B2 (en) * | 2017-05-10 | 2020-12-23 | 株式会社モリタ製作所 | Laser chips, laser treatment tools, laser treatment equipment, and laser treatment systems |
WO2019116280A1 (en) * | 2017-12-12 | 2019-06-20 | Novartis Ag | Laser probe |
SG11202008151QA (en) | 2018-02-26 | 2020-09-29 | Cynosure Inc | Q-switched cavity dumped sub-nanosecond laser |
CN108937957B (en) * | 2018-06-05 | 2021-11-09 | 武汉久乐科技有限公司 | Detection method, device and detection equipment |
US11234866B2 (en) * | 2019-04-19 | 2022-02-01 | Elios Vision, Inc. | Personalization of excimer laser fibers |
KR102572940B1 (en) * | 2020-10-30 | 2023-09-01 | 김영한 | Catheter inner tube for transferring light energy |
US20230200637A1 (en) * | 2021-12-29 | 2023-06-29 | Dorna Hakimimehr | Devices and methods for endoscopic neuroablation in the tympanic cavity |
WO2023183896A2 (en) * | 2022-03-23 | 2023-09-28 | Endo Uv Tech | Device and method for dilation of a tubular anatomical structure |
Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4627435A (en) * | 1983-05-14 | 1986-12-09 | Micra Limited | Surgical knives |
US4658817A (en) * | 1985-04-01 | 1987-04-21 | Children's Hospital Medical Center | Method and apparatus for transmyocardial revascularization using a laser |
FR2645354A1 (en) * | 1989-04-04 | 1990-10-05 | Tessier Bernard | Guide means, for example for laser radiation |
US5194712A (en) * | 1990-04-23 | 1993-03-16 | Jones Barbara L | Cutting tool using a diamond window |
WO1994028783A1 (en) * | 1993-06-14 | 1994-12-22 | American Surgical Technologies Corporation | Medical video endoscope system |
US5480050A (en) * | 1992-02-07 | 1996-01-02 | Surgilase, Inc. | Monolithic hollow waveguide method |
US5567471A (en) * | 1994-01-13 | 1996-10-22 | Rutgers, The State University Of New Jersey | Coherent, flexible, coated-bore hollow-fiber waveguide, and method of making same |
Family Cites Families (40)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4126136A (en) * | 1976-02-09 | 1978-11-21 | Research Corporation | Photocoagulating scalpel system |
US4469098A (en) * | 1978-12-18 | 1984-09-04 | Davi Samantha K | Apparatus for and method of utilizing energy to excise pathological tissue |
US4686979A (en) * | 1984-01-09 | 1987-08-18 | The United States Of America As Represented By The United States Department Of Energy | Excimer laser phototherapy for the dissolution of abnormal growth |
US4693244A (en) * | 1984-05-22 | 1987-09-15 | Surgical Laser Technologies, Inc. | Medical and surgical laser probe I |
US5176675A (en) * | 1985-04-24 | 1993-01-05 | The General Hospital Corporation | Use of lasers to break down objects for removal from within the body |
US4761056A (en) * | 1987-03-27 | 1988-08-02 | Kaiser Aerospace And Electronics Corporation | Compact helmet mounted display |
US5005944A (en) * | 1987-12-29 | 1991-04-09 | Luxar Corporation | Hollow lightpipe and lightpipe tip using a low refractive index inner layer |
US5071222A (en) * | 1987-12-29 | 1991-12-10 | Luxar Corporation | Lightpipe tip for contact laser surgery |
US4927231A (en) * | 1988-01-21 | 1990-05-22 | Acculase Inc. | Liquid filled flexible distal tip light guide |
US5097525A (en) * | 1988-03-04 | 1992-03-17 | Heraeus Lasersonics, Inc. | Optical transmission device |
US4917083A (en) * | 1988-03-04 | 1990-04-17 | Heraeus Lasersonics, Inc. | Delivery arrangement for a laser medical system |
US4877307A (en) * | 1988-07-05 | 1989-10-31 | Kaiser Aerospace & Electronics Corporation | Stereoscopic display |
EP0368512A3 (en) * | 1988-11-10 | 1990-08-08 | Premier Laser Systems, Inc. | Multiwavelength medical laser system |
US5207673A (en) * | 1989-06-09 | 1993-05-04 | Premier Laser Systems, Inc. | Fiber optic apparatus for use with medical lasers |
US4993412A (en) * | 1989-08-02 | 1991-02-19 | Eclipse Surgical Technologies, Inc. | Method and apparatus for removal of obstructive substance from body channels |
US5114403A (en) * | 1989-09-15 | 1992-05-19 | Eclipse Surgical Technologies, Inc. | Catheter torque mechanism |
US5044717A (en) * | 1990-01-18 | 1991-09-03 | Acculase, Inc. | Method and apparatus for coupling high energy laser to fiberoptic waveguide |
US5020880A (en) * | 1990-03-13 | 1991-06-04 | United Technologies Corporation | Low distortion window for use with high energy lasers |
US5125926A (en) * | 1990-09-24 | 1992-06-30 | Laser Engineering, Inc. | Heart-synchronized pulsed laser system |
US5280378A (en) * | 1990-10-19 | 1994-01-18 | I.L. Med, Inc. | Cyclically scanned medical laser |
US5505725A (en) * | 1990-10-30 | 1996-04-09 | Cardiogenesis Corporation | Shapeable optical fiber apparatus |
US5389096A (en) * | 1990-12-18 | 1995-02-14 | Advanced Cardiovascular Systems | System and method for percutaneous myocardial revascularization |
US5380316A (en) * | 1990-12-18 | 1995-01-10 | Advanced Cardiovascular Systems, Inc. | Method for intra-operative myocardial device revascularization |
US5222174A (en) * | 1991-02-25 | 1993-06-22 | Miles Gregory M | Fiber diverter |
EP0503934B1 (en) * | 1991-03-14 | 1995-12-20 | Sumitomo Electric Industries, Limited | Infrared optical part and method of making the same |
NZ242509A (en) * | 1991-05-01 | 1996-03-26 | Univ Columbia | Myocardial revascularisation using laser |
US5320620A (en) * | 1991-07-01 | 1994-06-14 | Laser Centers Of America | Laser surgical device with blunt flat-sided energy-delivery element |
FR2688098B1 (en) * | 1992-03-02 | 1994-04-15 | Lair Liquide | POWER LASER WITH UNCOATED DIAMOND WINDOW. |
US5222967B1 (en) * | 1992-04-08 | 1998-01-20 | Magnum Diamond Corp | Keratorefractive diamond blade and surgical method |
US5273788A (en) * | 1992-07-20 | 1993-12-28 | The University Of Utah | Preparation of diamond and diamond-like thin films |
US5376099A (en) * | 1992-09-17 | 1994-12-27 | Kmi, Inc. | Undercut diamond surgical blade and method of using the same |
IL106302A (en) * | 1993-07-09 | 1996-12-05 | Univ Ramot | Hollow waveguide tips for controlling beam divergency and methods of making such tips |
EP0714255A4 (en) * | 1993-08-18 | 1997-06-11 | Vista Medical Tech | Optical surgical device |
JP2591032Y2 (en) * | 1993-12-20 | 1999-02-24 | 株式会社モリテックス | Optical fiber laser light guide diffuser probe |
US5532852A (en) * | 1994-02-23 | 1996-07-02 | Kaiser Aerospace And Electronics Corporation | High speed, high ambient viewability liquid crystal display assembly |
US5495541A (en) * | 1994-04-19 | 1996-02-27 | Murray; Steven C. | Optical delivery device with high numerical aperture curved waveguide |
US5591157A (en) * | 1994-09-07 | 1997-01-07 | Hennings; David R. | Method and apparatus for tympanic membrane shrinkage |
US5558668A (en) * | 1994-10-11 | 1996-09-24 | Plc Medical Systems, Inc. | Medical laser treatment system and method |
US5591159A (en) * | 1994-11-09 | 1997-01-07 | Taheri; Syde A. | Transcavitary myocardial perfusion apparatus |
US5658275A (en) * | 1995-06-07 | 1997-08-19 | Trimedyne, Inc. | Surgical laser instrument |
-
1997
- 1997-06-30 US US08/885,064 patent/US5951543A/en not_active Expired - Lifetime
-
1998
- 1998-06-17 JP JP50559999A patent/JP2002507135A/en active Pending
- 1998-06-17 EP EP98930346A patent/EP0993279A1/en not_active Withdrawn
- 1998-06-17 WO PCT/US1998/012652 patent/WO1999000062A1/en not_active Application Discontinuation
- 1998-06-17 CN CN98806698A patent/CN1261774A/en active Pending
- 1998-06-17 AU AU79756/98A patent/AU7975698A/en not_active Abandoned
Patent Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4627435A (en) * | 1983-05-14 | 1986-12-09 | Micra Limited | Surgical knives |
US4658817A (en) * | 1985-04-01 | 1987-04-21 | Children's Hospital Medical Center | Method and apparatus for transmyocardial revascularization using a laser |
FR2645354A1 (en) * | 1989-04-04 | 1990-10-05 | Tessier Bernard | Guide means, for example for laser radiation |
US5194712A (en) * | 1990-04-23 | 1993-03-16 | Jones Barbara L | Cutting tool using a diamond window |
US5480050A (en) * | 1992-02-07 | 1996-01-02 | Surgilase, Inc. | Monolithic hollow waveguide method |
WO1994028783A1 (en) * | 1993-06-14 | 1994-12-22 | American Surgical Technologies Corporation | Medical video endoscope system |
US5567471A (en) * | 1994-01-13 | 1996-10-22 | Rutgers, The State University Of New Jersey | Coherent, flexible, coated-bore hollow-fiber waveguide, and method of making same |
Cited By (16)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6699236B1 (en) | 1999-06-29 | 2004-03-02 | Herman Philip Godfried | Cutting blade for surgical instrument |
WO2001000100A1 (en) * | 1999-06-29 | 2001-01-04 | Drukker International Bv | Cutting blade for surgical instrument |
EP1211997A4 (en) * | 1999-08-11 | 2009-06-17 | Ceramoptec Gmbh | Diode laser scalpel |
EP1211997A2 (en) * | 1999-08-11 | 2002-06-12 | CeramOptec GmbH | Diode laser scalpel |
WO2001087176A1 (en) * | 2000-05-15 | 2001-11-22 | Clinicon Corporation | Optical surgical system and method |
JP2002281970A (en) * | 2001-01-17 | 2002-10-02 | Univ Osaka | Method for processing cell |
US8486123B2 (en) | 2003-05-28 | 2013-07-16 | Bredent Medical Gmbh & Co., Kg | Micro-organism-reducing device |
EP1740988A4 (en) * | 2004-04-08 | 2008-11-12 | Omniguide Inc | Photonic crystal fibers and medical systems including photonic crystal |
EP1740988A2 (en) * | 2004-04-08 | 2007-01-10 | OmniGuide, Inc. | Photonic crystal fibers and medical systems including photonic crystal |
EP2083904A2 (en) * | 2006-11-03 | 2009-08-05 | Mobius Therapeutics, LLc | Apparatus and method for application of a pharmaceutical to the tympanic membrane for photodynamic laser myringotomy |
EP2083904A4 (en) * | 2006-11-03 | 2009-12-30 | Mobius Therapeutics Llc | Apparatus and method for application of a pharmaceutical to the tympanic membrane for photodynamic laser myringotomy |
RU2533523C2 (en) * | 2009-07-23 | 2014-11-20 | Конинклейке Филипс Электроникс Н.В. | Optic blade and electric hair cutting device |
US9063299B2 (en) | 2009-12-15 | 2015-06-23 | Omni Guide, Inc. | Two-part surgical waveguide |
WO2012013687A1 (en) * | 2010-07-30 | 2012-02-02 | Element Six N.V. | A diamond window component for a laser tool |
CN103179915A (en) * | 2010-07-30 | 2013-06-26 | 六号元素股份有限公司 | A diamond window component for a laser tool |
US9040131B2 (en) | 2010-07-30 | 2015-05-26 | Element Six N.V. | Diamond window component for a laser tool |
Also Published As
Publication number | Publication date |
---|---|
EP0993279A1 (en) | 2000-04-19 |
CN1261774A (en) | 2000-08-02 |
JP2002507135A (en) | 2002-03-05 |
US5951543A (en) | 1999-09-14 |
AU7975698A (en) | 1999-01-19 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US5951543A (en) | Delivery system and method for surgical laser | |
Verdaasdonk et al. | Laser light delivery systems for medical applications | |
US5151098A (en) | Apparatus for controlled tissue ablation | |
US4658817A (en) | Method and apparatus for transmyocardial revascularization using a laser | |
JP4427327B2 (en) | Non-perforated leaky surgery | |
US6464693B1 (en) | Myocardial revascularization | |
WO2001087176A1 (en) | Optical surgical system and method | |
US7220256B2 (en) | Laser system and method for treatment of biological tissues | |
US11253317B2 (en) | Soft tissue selective ablation surgical systems | |
EP2560569B1 (en) | Flash vaporization surgical systems | |
US6203540B1 (en) | Ultrasound and laser face-lift and bulbous lysing device | |
US5057099A (en) | Method for laser surgery | |
CN102512242B (en) | Hair-growth control device and hair-growth control method | |
EP0165301B1 (en) | Excimer laser for medical treatment on organic tissue in biolocical systems at a pathological situs | |
JPH10155805A (en) | Surgery method by fixed position laser | |
US20220183882A1 (en) | Devices and methods for treating aqueous collector channels of an eye to reduce intraocular pressure | |
WO2016184215A1 (en) | Imaging dot matrix laser treatment instrument | |
WO2016042547A1 (en) | Methods and devices for thermal surgical vaporization and incision of tissue | |
EP2358286B1 (en) | Dynamic laser pulse systems | |
US20170281256A1 (en) | Methods and devices for thermal surgical vaporization and incision of tissue | |
Verdaasdonk | Medical lasers: fundamentals and applications | |
Bagley et al. | Endourologic use of the holmium laser | |
JP2008518661A (en) | Guided cutting treatment apparatus and method | |
Slatkine et al. | Instrumentation for officelaser surgery | |
JP6846759B2 (en) | Laser chips, laser treatment tools, laser treatment equipment, and laser treatment systems |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
WWE | Wipo information: entry into national phase |
Ref document number: 98806698.X Country of ref document: CN |
|
AK | Designated states |
Kind code of ref document: A1 Designated state(s): AL AM AT AU AZ BA BB BG BR BY CA CH CN CU CZ DE DK EE ES FI GB GE GH GM GW HU ID IL IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT UA UG UZ VN YU ZW |
|
AL | Designated countries for regional patents |
Kind code of ref document: A1 Designated state(s): GH GM KE LS MW SD SZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN ML MR NE SN TD TG |
|
DFPE | Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101) | ||
121 | Ep: the epo has been informed by wipo that ep was designated in this application | ||
WWE | Wipo information: entry into national phase |
Ref document number: 1998930346 Country of ref document: EP |
|
WWP | Wipo information: published in national office |
Ref document number: 1998930346 Country of ref document: EP |
|
REG | Reference to national code |
Ref country code: DE Ref legal event code: 8642 |
|
NENP | Non-entry into the national phase |
Ref country code: CA |
|
WWW | Wipo information: withdrawn in national office |
Ref document number: 1998930346 Country of ref document: EP |